Provider First Line Business Practice Location Address:
542 6TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25701-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-522-3544
Provider Business Practice Location Address Fax Number:
740-236-4184
Provider Enumeration Date:
03/19/2007